What Is Decorticate Posturing And What Does It Indicate?

Decorticate posturing is a posturing that indicates a severe damage in the brain. This abnormal posturing makes a person suffer from clenched fists, bent arms and legs that are held out straight. However, this is not as serious as decerebrate posture, wherein the particular kind of posturing appears on both sides of one's body. Let's discuss the condition in detail.

What Is Decorticate Posturing?

Abnormal posturing is different from a bad posture, which might be temporary. When talking about decorticate posturing, we refer to abnormal posturing that is linked to rigid body movements and positions of the body that show chronic abnormality. But this condition is different from poor posture such as slumping over.

Posture abnormality refers to holding a particular body position or in some cases to move parts of the body in an abnormal manner. Severe spinal and brain injuries are the prime culprits behind the occurrence of such abnormal posturing - decorticate posturing being one such abnormal posturing ailment.

This kind of abnormal posturing causes the arms to bend inward towards the body. The wrists and fingers appear to be bent such that they are held on the chest. People with this condition need medical attention immediately.

This kind of posturing is in response to noxious stimuli. It affects the upper extremity by causing flexion of the wrist, fingers and the arm in general. It affects the lower extremity by causing extension, plantar flexion and internal rotation.

Under normal circumstances, when a muscle contracts, the muscles present on the other side of the joint offer resistance to this contraction. However, when there is abnormal posturing, the muscles fail to offer resistance when contraction occurs.

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What Does It Indicate?

This posturing signals that there is damage to the nerve pathway that connects the spinal cord and the brain.

This condition is more common in comatose patients who have developed lesions above the red nucleus and below the thalamus.

What Causes Decorticate Posturing?

The following are some of the causes of decorticate posturing:

• Brain tumour
• Infection (for instance Reve syndrome)
• Brain stem tumour
• Stroke
• Bleeding in the brain
• Brain problem (due to infection, poisoning or drugs)
• Brain injury
• Loss of liver function after a liver failure
• Increased pressure in the brain

How Is Decorticate Posturing Treated?

A reduced level of alertness usually accompanies any kind of abnormal posturing. This requires immediate medical care. The person should be rushed to a hospital and treatment should begin right away.

The person with such an abnormal posturing would receive emergency treatment. Breathing assistance with the use of a breathing tube is provided to the patient. The person is most likely to be placed in the ICU (intensive care unit) in the hospital.
Once the condition of the patient stabilizes to a certain extent, family history might be obtained along with a detailed examination to understand the severity of the illness. A thorough examination of the nervous system and the brain is conducted.

If the patient is not in a condition to speak, then a close family member would need to address the questions of the doctor which might include the time when the symptoms started, if any pattern to the episodes of abnormal posturing exists, if the body posture is the same always, history of drug use or head injury and symptoms that occurred prior to the occurrence of abnormal posturing.

The following tests are usually conducted so that the right forms of treatment can be provided:

• Brain wave testing or electroencephalography
• Blood and urine tests (check for blood counts, presence of toxic substance/drugs, measurement of minerals and chemicals in the body)
• MRI of the head
• CT scan of the head
• Collection of cerebrospinal fluid through a lumbar puncture
• Intracranial pressure monitoring
• Cerebral angiography

If immediate treatment is not given to the patient then there could be permanent brain damage, leading to life-threatening situations such as:

• Seizures
• Paralysis
• Coma
• Inability to communicate

Immediate treatment steps would include treating the condition that has caused decorticate posturing. Most of the time a surgical procedure might be required in case there is severe head injury or infection/bleeding in the brain.

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Is Complete Recovery Possible?

In case of brain injuries, doctors say that a complete recovery if not observed within two years post the medical treatment offered, makes it unlikely for the person to recover completely. This holds true for the after-effects of brain injury/infection as well such as the occurrence of decorticate posturing.

Physical injury of the brain can also be categorized based on grades such as mild, moderate and severe. These grades also play an important role in how soon a brain injured person can recover. However, in some rare cases, the level of injury may not be fully predictive in identifying the level of recovery in the future.